Dr Richard Edwards (Senior Lecturer in Epidemiology, University of Otago) argues on ethically grounded research, that we need new approaches to eradicating smoking from our society. This will require a re-framing of the public discourse and pursuing practical public policies geared to achieving clear goals. He advances six ‘radical’ solutions to get there. http://dosomething.org.nz

1. Do something! Tobacco smoking in New Zealand – where are we now and where should we be going? Richard Edwards Health Promotion and Policy Research Unit (HePPRU) Department of Public Health, University of Otago, Wellington

5. Percentage smoking by ethnicity, 1991-2008

6. Per-Capita Tobacco Consumption in New Zealand, 1970-2008 Data: Stats NZ

7. So why is that society’s problem? Smokers bring it on themselves.

9. The delusion gap

10. Tobacco industry and secondhand smoke/smoke free public places “ The anti-smoking forces’ latest tack … on the passive smoking issue … is quite a different matter. What the smoker does to himself may be his business, but what the smoker does to the non-smokers is quite a different matter …. This we see as the most dangerous development to the viability of the tobacco industry that has yet occurred” Tobacco Institute, 1978 Secondhand smoke is “probably the single most important challenge we face.” Vice Chair of Phillip Morris (W Murray), 1989

13. 1950 Epidemiologic Evidence Richard Doll & A. Bradford Hill ( British Medical Journal UK) Smoking and Carcinoma of the Lung; Preliminary Report “ We therefore conclude that smoking is a factor, and an important factor , in the production of carcinoma of the lung.”

23. US EPA Air Quality Index

24. Windows closed Do we protect children from SHS in cars?

25. The Usual Suspects

28. What is missing?

37. Ban Point of Sale Displays

38. Plain packaging

39. Extend smokefree legislation - SmokefreeParks in New Zealand

46. ‘ Maori Murder’ and ‘Endangered species’ Campaigns

47. Paradigms Evidence of success Evidence required for intervention Intervention Types of evidence Public/policy-maker view Type Frame ‘ Pro-smoking’ influences e.g. PoS displays Asbestos/dioxin Exposure

48. Protection, precautionary principle Paradigms Removal of exposure Evidence of success Presence of exposure Evidence required for intervention Remove Intervention Toxicological, epidemiological Types of evidence Any exposure = unacceptable Public/policy-maker view Environmental toxin Type Poison Frame ‘ Pro-smoking’ influences e.g. PoS displays Asbestos/dioxin Exposure

49. Cautionary principle, balanced, evidence-based Protection, precautionary principle Paradigms Reduced uptake, increased quitting, reduced prevalence, no/minimal adverse effects Removal of exposure Evidence of success Exp/outcome, intervention effectiveness, lack of adverse effects Presence of exposure Evidence required for intervention Policy measures e.g. PoS regulations, PoS ban Remove Intervention Epidemiological – exp/outcome (strong), intervention/outcome (probable but incomplete) Toxicological, epidemiological (NB v. weak for low exposure) Types of evidence Possible cause of uptake (what’s the evidence?) Any exposure = unacceptable Public/policy-maker view Potential influence on behaviour Environmental toxin Type Risk factor Poison Frame ‘ Pro-smoking’ influences e.g. PoS displays Asbestos/dioxin Exposure

50. Remember the human suffering behind the smoking statistics